Epidemiology of combat sport-related fractures treated in United States emergency departments

Abstract

Objectives

To determine the incidence and demographic characteristics of combat sport-related fractures treated in U.S. emergency departments and compare demographic variables, injury characteristics, and disposition among boxing-, wrestling-, and martial arts (MA)-related fractures.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for boxing, wrestling, and MA-related fractures from 2014 to 2023. Analyses included descriptive statistics and comparative tests (chi-square, Fisher's, Mann-Whitney U, Kruskal-Wallis).

Results

Of 22,233 combat sport-related injuries, 4391 (19.7%) were fractures: 929 boxing (21.2%), 1938 wrestling (44.1%), and 1524 MA (34.7%). NEISS weighted estimates correspond to 80,182 injuries and 14,555 fractures annually. Fractures comprised the greatest proportion of total injuries in boxing (21.6%) (p = 0.002), and the mean age at the time of fracture was highest in the boxing group (25.18 ± 11.49 years) (p < 0.001). Boxing fractures most often involved the hand (50.4%), wrestling the shoulder (15.7%), and MA the toes (15.9%) (p < 0.001). Pediatric patients (<18 years) represented 64.9% of fractures, most commonly lower arm (15.2%), while adults most often sustained hand fractures (31.0%) (p < 0.001). Wrestling (88.2%) and MA (56.3%) fractures occurred mainly in pediatric patients, whereas boxing fractures were more frequent in adults (69.6%) (p < 0.001). Males accounted for 85.2% of fractures, most often involving the hand (16.7%), while females most frequently sustained shoulder fractures (14.5%) (p < 0.001). Patients with boxing fractures were the most likely to be treated and released (96.3%) (p < 0.001).

Conclusion

Combat sport-related fractures show distinct patterns by sport, age, and sex, insights that can inform targeted injury prevention and safety strategies.